HORMONAL IUDs AVAILABLE IN AUSTRALIA COMPARISON CHART TOOL FOR CLINICIANS TO USE WITH PATIENTS TO ASSIST IN DECISION MAKING Kyleena Mirena 19.5 mg Levonorgestrel IUD 52 mg Levonorgestrel IUD Cost of the IUD PBS (with a medicare card): PBS (with a medicare card): Approximately $5.60 with health care Approximately $5.60 with health care Price may differ slightly between card or $40 without card or $40 without pharmacies. Approximately $170 on private Approximately $213 on private prescription (if no Medicare card) prescription (if no Medicare card) Please check with your health care provider for any costs associated with the IUD insertion procedure.

Reasons for using the IUD • Contraception • Contraception • Management of heavy periods • Can be used as the progestogen part of menopausal hormone therapy

How long does the IUD work? 5 years 5 years If aged 45 years or older at the time (After 5 years the IUD can be of insertion for contraception or replaced for ongoing use) menstrual control can be left in until 55 years of age.1

Can the IUD be used as the No Yes. Must be replaced every 5 years progestogen part of menopausal regardless of age at insertion. hormone therapy?

How effective is the IUD at 99.7% 2 99.9% 3 preventing pregnancy?

How common are ectopic If pregnancy occurs with a hormonal IUD about half of those pregnancies will pregnancies on the IUD? be ectopic (outside the uterus). 2, 3 However because IUDs are so effective at preventing pregnancy, IUD users are less likely to have an ectopic pregnancy while they have an IUD than when they do not have an IUD.

How much hormone is in the Approximately 140ng/L Approximately 280ng/L blood stream at 90 days? 4 This is a low amount of hormone and is This is a low amount of hormone around half compared with the Mirena IUD

Size difference (mm) Inserter tube width (mm) 3.8 4.4 Device width (mm) 28 32 Length (mm) 30 32 Discomfort during insertion In a study where people reported pain levels during insertion of their IUDs, pain procedure 5 with insertion was rated as none or mild by the majority. However some report higher levels of pain during Mirena insertion. What changes to bleeding There can be increased bleeding and spotting days in the first 6 months of use patterns may occur? 5 with both IUDs. By 3 years of use most people have fewer than 4 bleeding or spotting days per month. There are slightly fewer bleeding and spotting days per month with Mirena compared to the Kyleena.

Rate of complete cessation of 12.3 % at 1 year 18.6% at 1 year bleeding (no periods) 6 23 % at 5 years 30-40% at 5 years

Is the IUD recommended for Not specifically studied in this Yes. Bleeding reduction of around management of heavy periods? population 85% 7

Will the IUD help reduce period In a study the baseline number of people with no period pain at the start of the pain? study was 50%. This improved to 80% in users of both IUDs at 3 years. 5

What are the hormonal side There is not enough evidence to indicate whether lower systemic hormone effects exposure with Kyleena is associated with less hormonal side effects. Hormonal side effects with both IUDs may include headache, acne, breast tenderness, mood changes and irregular bleeding. If these occur most will resolve with continued use of the IUDs.

Do any other medications interact Neither Mirena or Kyleena are affected by other medications. with the IUDs? 8

Abbreviations: LNG-IUD=levonorgestrel intrauterine device PBS=Pharmaceutical Benefits Scheme HCC= Health Care Card

References: 1. Contraception for Users Over 40 Years: Information for Health Practitioners 2020 [cited 2020 16 October]. Available from: https://www.fpv.org.au/resource/contraception-for-users-over-40-years-health-practitioner faqs. 2. Gemzell-Danielsson K, Apter D, Dermout S, Faustmann T, Rosen K, Schmelter T, et al. Evaluation of a new, low-dose levonorgestrel intrauterine contraceptive system over 5 years of use. Eur J Obstet Gynecol Reprod Biol. 2017;210:22-8. 3. Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrelreleasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. 2015;91(4):280-3. 4. Apter D, Gemzell-Danielsson K, Hauck B, Rosen K, Zurth C. Pharmacokinetics of two low-dose levonorgestrelreleasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies. Fertility and sterility. 2014;101(6):1656-62 e1-4. 5. Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertility and sterility. 2012;97(3):616-22 e1-3. 6. Goldthwaite LM, Creinin MD. Comparing bleeding patterns for the levonorgestrel 52 mg, 19.5 mg, and 13.5 mg intrauterine systems. Contraception. 2019;100(2):128-31. 7. Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, Muysers C, Jensen JT. Levonorgestrel-Releasing Intrauterine System or Medroxyprogesterone for Heavy Menstrual Bleeding: A Randomized Controlled Trial. Obstet Gynecol. 2010;116(3):625-32.